Chronic Fatigue Research Articles

Clinical and Diagnostic Features of Post-Acute COVID-19 Vaccination Syndrome (PACVS).

Post-acute COVID-19 vaccination syndrome (PACVS) is a chronic disease triggered by SARS-CoV-2 vaccination (estimated prevalence 0.02%). PACVS is discriminated from the normal post-vaccination state by altered receptor antibodies, most notably angiotensin II type 1 and alpha-2B adrenergic receptor antibodies. Here, we investigate the clinical phenotype using a study registry encompassing 191 PACVS-affected persons (159 females/32 males; median ages: 39/42 years). Unbiased clustering (modified Jaccard index) of reported symptoms revealed a prevalent cross-cohort symptomatology of malaise and chronic fatigue (>80% of cases). Overlapping clusters of (i) peripheral nerve dysfunction, dysesthesia, motor weakness, pain, and vasomotor dysfunction; (ii) cardiovascular impairment; and (iii) cognitive impairment, headache, and visual and acoustic dysfunctions were also frequently represented. Notable abnormalities of standard serum markers encompassing increased interleukins 6 and 8 (>80%), low free tri-iodine thyroxine (>80%), IgG subclass imbalances (>50%), impaired iron storage (>50%), and increased soluble neurofilament light chains (>30%) were not associated with specific symptoms. Based on these data, 131/191 participants fit myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and simultaneously also several other established dysautonomia syndromes. Furthermore, 31/191 participants fit none of these syndromes. In conclusion, PACVS could either be an outlier of ME/CFS or a dysautonomia syndrome sui generis.

Association of anxiety and depression with breast implant illness syndrome (BII): a prospective observational cross-sectional study

Introduction: Breast Implant Illness syndrome (BII), popularly known as “silicone disease”, has no defined pathophysiology or recognition by the WHO. It consists of systemic symptoms such as joint pain, muscle pain, confusion, memory loss/cognitive problems, chronic fatigue, and immune diseases. In some more recent studies, anxiety and depression have been observed as an incident characteristic of the syndrome. Objective: It was to relate the appearance of anxiety and depression pathologies with the development of Breast Implant Illness syndrome in women with breast implants. Methods: To prepare the following prospective observational cross-sectional study, 132 women who had breast implants were interviewed and answered an online questionnaire with 18 questions about the breast implant that was disseminated through social networks. To obtain the data, questions about pre-operative and post-operative signs and symptoms were crossed, this data was subsequently struck and finally, another cross was carried out with the other unknown, symptoms were diagnosed by doctors. Results: The validation analysis of the questionnaire proposed in this study using Cronbach's alpha (α) statistical technique showed that the reliability rating was high, with alpha (α)=0.82. It was noted that 31% of women who did not have any characteristic signs and symptoms presented after placement and of these 22 women were diagnosed by doctors. And at the other intersection, it was clear that 25% presented depression after the placement of the breast implant and 23 of these women were diagnosed by doctors. Conclusion: It can be stated that anxiety and depression are pathologies associated with Breast Implant Illness syndrome.

The significance of the apelinergic system in doxorubicin-induced cardiotoxicity.

Cancer is the leading cause of death worldwide, and the number of cancer-related deaths is expected to increase. Common types of cancer include skin, breast, lung, prostate, and colorectal cancers. While clinical research has improved cancer therapies, these treatments often come with significant side effects such as chronic fatigue, hair loss, and nausea. In addition, cancer treatments can cause long-term cardiovascular complications. Doxorubicin (DOX) therapy is one example, which can lead to decreased left ventricle (LV) echocardiography (ECHO) parameters, increased oxidative stress in cellular level, and even cardiac fibrosis. The apelinergic system, specifically apelin and its receptor, together, has shown properties that could potentially protect the heart and mitigate the damages caused by DOX anti-cancer treatment. Studies have suggested that stimulating the apelinergic system may have therapeutic benefits for heart damage induced by DOX. Further research in chronic preclinical models is needed to confirm this hypothesis and understand the mechanism of action for the apelinergic system. This review aims to collect and present data on the effects of the apelinergic system on doxorubicin-induced cardiotoxicity.

Fibromyalgia pathogenesis explained by a neuroendocrine multistable model.

Fibromyalgia (FM) is a central disorder characterized by chronic pain, fatigue, insomnia, depression, and other minor symptoms. Knowledge about pathogenesis is lacking, diagnosis difficult, clinical approach puzzling, and patient management disappointing. We conducted a theoretical study based on literature data and computational analysis, aimed at developing a comprehensive model of FM pathogenesis and addressing suitable therapeutic targets. We started from the evidence that FM must involve a dysregulation of central pain processing, is female prevalent, suggesting a role for the hypothalamus-pituitary-gonadal (HPG) axis, and is stress-related, suggesting a role for the HP-adrenocortical (HPA) axis. Central pathogenesis was supposed to involve a pain processing loop system including the thalamic ventroposterolateral nucleus (VPL), the primary somatosensory cortex (SSC), and the thalamic reticular nucleus (TRN). For decreasing GABAergic and/or increasing glutamatergic transmission, the loop system crosses a bifurcation point, switching from monostable to bistable, and converging on a high-firing-rate steady state supposed to be the pathogenic condition. Thereafter, we showed that GABAergic transmission is positively correlated with gonadal-hormone-derived neurosteroids, notably allopregnanolone, whereas glutamatergic transmission is positively correlated with stress-induced glucocorticoids, notably cortisol. Finally, we built a dynamic model describing a multistable, double-inhibitory loop between HPG and HPA axes. This system has a high-HPA/low-HPG steady state, allegedly reached in females under combined premenstrual/postpartum brain allopregnanolone withdrawal and stress condition, driving the thalamocortical loop to the high-firing-rate steady state, and explaining the connection between endocrine and neural mechanisms in FM pathogenesis. Our model accounts for FM female prevalence and stress correlation, suggesting the use of neurosteroid drugs as a possible solution to currently unsolved problems in the clinical treatment of the disease.

Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis.

Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), long COVID (LC) and post-COVID-19 vaccine syndrome show similarities in their pathophysiology and clinical manifestations. These disorders are related to viral or adjuvant persistence, immunological alterations, autoimmune diseases and hormonal imbalances. A developmental model is postulated that involves the interaction between immune hyperactivation, autoimmune hypophysitis or pituitary hypophysitis, and immune depletion. This process might begin with a deficient CD4 T-cell response to viral infections in genetically predisposed individuals (HLA-DRB1), followed by an uncontrolled immune response with CD8 T-cell hyperactivation and elevated antibody production, some of which may be directed against autoantigens, which can trigger autoimmune hypophysitis or direct damage to the pituitary, resulting in decreased production of pituitary hormones, such as ACTH. As the disease progresses, prolonged exposure to viral antigens can lead to exhaustion of the immune system, exacerbating symptoms and pathology. It is suggested that these disorders could be included in the autoimmune/adjuvant-induced inflammatory syndrome (ASIA) because of their similar clinical manifestations and possible relationship to genetic factors, such as polymorphisms in the HLA-DRB1 gene. In addition, it is proposed that treatment with antivirals, corticosteroids/ginseng, antioxidants, and metabolic precursors could improve symptoms by modulating the immune response, pituitary function, inflammation and oxidative stress. Therefore, the purpose of this review is to suggest a possible autoimmune origin against the adenohypophysis and a possible improvement of symptoms after treatment with corticosteroid replacement therapy.

Heart Rate Variability Biofeedback Efficacy on Fatigue and Energy Levels in Fibromyalgia: A Secondary Analysis of RCT NCT0412183.

Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically those related to perceived energy and fatigue symptoms in a randomized controlled trial (RCT) assessing the efficacy of heart rate variability biofeedback (HRV-BF) as an adjunctive treatment for FMs. Methods: Sixty-four FMs patients were randomly assigned to either receive 10 HRV-BF training sessions alongside standard pharmacological therapy (experimental group) or standard therapy alone for 10 weeks (control group). For this secondary analysis, potential improvements in specific items were evaluated regarding perceived energy (Item 10 of the Short-Form Health Survey), the ability to walk and climb stairs (Item 7 and Item 11 of the Fibromyalgia Impact Questionnaire, respectively), and the impact of pain on movement ability (Item 17 of the Bodily and Emotional Perception of Pain). Results: The experimental group demonstrated an improvement in the perception of energy, the ability to walk, and the impact of pain on movement ability. However, the same improvement was not observed in the ability to climb stairs. Conclusions: Fatigue assessment has emerged as a crucial factor for evaluating treatment efficacy in FMs and related conditions linked to altered energy levels, such as bipolar depression, and can offer valuable insights for precisely guiding HRV-BF treatments. ClinicalTrials.gov with code: NCT04121832.

Research progress on pathogenesis of chronic fatigue syndrome and treatment of traditional Chinese and Western medicine

Chronic Fatigue Syndrome (CFS) is a complex and perplexing medical disorder primarily characterized by persistent and debilitating fatigue, often accompanied by a constellation of symptoms, including weakness, dyspnea, arthromyalgia, sore throat, and disrupted sleep patterns. CFS is defined by its persistent or recurrent manifestation for a minimum duration of six months, marked by an enduring and unrelenting fatigue that remains refractory to rest. In recent decades, this condition has garnered significant attention within the medical community. While the precise etiology of CFS remains elusive, it is postulated to be multifactorial. CFS is potentially associated with various contributory factors such as infections, chronic stress, genetic predisposition, immune dysregulation, and psychosocial influences. The pathophysiological underpinnings of CFS encompass viral infections, immune system dysregulation, neuroendocrine aberrations, heightened oxidative stress, and perturbations in gut microbiota. Presently, clinical management predominantly relies on pharmaceutical interventions or singular therapeutic modalities, offering alleviation of specific symptoms but exhibiting inherent limitations. Traditional Chinese Medicine (TCM) interventions have emerged as a promising paradigm, demonstrating notable efficacy through their multimodal, multi-target, multi-pathway approach, and holistic regulatory mechanisms. These interventions effectively address the lacunae in contemporary medical interventions. This comprehensive review synthesizes recent advancements in the understanding of the etiological factors, pathophysiological mechanisms, and interventional strategies for CFS, drawing from a corpus of domestic and international literature. Its aim is to furnish valuable insights for clinicians actively involved in diagnosing and treating CFS, as well as for pharmaceutical researchers delving into innovative drug development pathways. Moreover, it seeks to address the intricate challenges confronted by clinical practitioners in managing this incapacitating condition.

False Alarm: XMRV, Cancer, and Chronic Fatigue Syndrome.

Xenotropic murine leukemia virus (MLV)-related virus (XMRV) was first described in 2006 in some human prostate cancers. But it drew little attention until 2009, when it was also found, as infectious virus and as MLV-related DNA, in samples from people suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This discovery was rapidly followed by efforts of the international research community to understand the significance of the association and its potential to spread widely as an important human pathogen. Within a few years, efforts by researchers worldwide failed to repeat these findings, and mounting evidence for laboratory contamination with mouse-derived virus and viral DNA sequences became accepted as the explanation for the initial findings. As researchers engaged in these studies, we present here a historical review of the rise and fall of XMRV as a human pathogen, and we discuss the lessons learned from these events.

Widespread Myalgia and Chronic Fatigue: Phagocytes from Macrophagic Myofasciitis Patients Exposed to Aluminum Oxyhydroxide-Adjuvanted Vaccine Exhibit Specific Inflammatory, Autophagic, and Mitochondrial Responses.

(1) Background: Macrophagic myofasciitis (MMF) is an inflammatory histopathological lesion demonstrating long-term biopersistence of vaccine-derived aluminum adjuvants within muscular phagocytic cells. Affected patients suffer from widespread myalgia and severe fatigue consistent with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a poorly understood disorder suspected to result from chronic immune stimulation by infectious and inorganic particles. (2) Methods: In this study we determined the immuno-metabolic properties of MMF phagocytic cells compared to controls, at rest and upon exposure to aluminum oxyhydroxide adjuvant, with or without adsorbed antigens, using protein quantification and an oxygen consumption assay. (3) Results: MMF and control cells similarly internalized the adjuvant and vaccine but MMF cells specifically expressed Rubicon and Nox2, two molecules unique to the LC3-associated phagocytosis (LAP) machinery, a non-canonical autophagic pathway able to downregulate canonical autophagy. MMF cells exhibited an altered inflammatory secretome, producing more pain-inducing CXC chemokines and less TNF-α than controls, consistent with chronic myalgia and exhaustion of the immune system previously documented in ME/CFS. MMF cells exhibited mitochondrial metabolism dysfunction, with exacerbated reaction to adjuvanted vaccine, contrasting with limited spare respiratory capacity and marked proton leak weakening energy production. (4) Conclusions: MMF phagocytes seemingly use LAP to handle aluminum oxyhydroxide vaccine particles, secrete pain-inducing molecules, and exhibit exacerbated metabolic reaction to the vaccine with limited capacity to respond to ongoing energetic requests.

P-326 Improving quality of life and awareness of endometriosis patients using personalized web app with indications about non pharmacological support and lifestyle changes

Abstract Study question Is it possible to improve quality of life of endometriosis patients using a personalized web app suggesting non-pharmacological interventions and lifestyle changes ? Summary answer A personalized web app is useful to improve awareness and quality of life of endometriosis patients What is known already Our project is based on four main considerations: first, there is a lack of information and awareness about endometriosis symptoms and possible treatments among affected patients; second, there is no definitive cure yet and nor medications nor surgery can be considered as definitive solution; third, web instruments and social media are useful nowadays to spread knowledges about the disease; fourth, non-pharmacological support is a real instrument to better deal with the symptoms and improve quality of life. Our web app is located in this context. Study design, size, duration This is a pilot study structured on one year follow-up of symptoms and quality of life of patients with confirmed endometriosis, giving them non-pharmacological suggestions and lifestyle changes useful to better face the pathology using a personalized web app. So far, we collected data from 50 patients. Preliminary results will be based on six months followup. The project started in December 2023 Participants/materials, setting, methods Participants are patients with diagnosis of endometriosis -ultrasound,mri and surgery - between 24-45 years old, using a personalized web app in which suggestions about non-pharmacological support/lifestyle changes, given by a multidisciplinary team, are contained. Indications received are based on pelvic symptoms - dysmenorrhea, dyspareunia, chronic pelvic pain- and main systemic symptoms - chronic fatigue syndrome, migraine, bowel implications/endobelly, urinary disfunctions. Quality of life before and after the indications received was measured using EHP-30 questionnaire. Main results and the role of chance A multidisciplinary team - specialists in gynaecology, infertility, urology, pelvic floor, nutrition, chronic pain, acupuncture, psychology, yoga/pilates, law- created a web app in which indications about non-pharmacological treatments/lifestyle changes to face endometriosis symptoms are contained. We divided the indications based on main pelvic symptoms of endometriosis - dysmenorrhea, dyspareunia, chronic pelvic pain- and main systemic symptoms - chronic fatigue syndrome, migraine, bowel implications/endobelly, urinary disfunctions. For each protocol, in validation by Italian ministry of health and structured in six months indications to be followed, we gave correct informations about the pathophysiology of endometriosis, related symptoms and how to recognize them, which specialist patients should consult, what kind of supplements are useful to reduce chronic inflammation in addition/without medical therapy, implications on fertility, nutrition indications, psycological support, physical activity, when surgery should be considered or where to refer to have a proper treatment. We also created the first online community formed by specialists and patients: patients web groups are useful to share experiences, but there is risk of misinformation. The presence of specialists in a web-based community with patients could also make the difference. So far, following our indications, 50 patients reported a significant improvement in quality of life Limitations, reasons for caution Limitation in patients selection is the difference in methods of diagnosis, not always performed by specialists. We do not find reasons for caution: non-pharmacological support exists. Correct informations in unique source raise awareness, the role of supplements, pelvic floor treatments, acupuncture, nutrition, psycological support are widely recognized in literature Wider implications of the findings We aim to properly support patients in management of endometriosis. With easily wide-spreading instruments such a web app created by specialists, supported by social media and online community, we also aim to reduce the diagnostic delay. Results so far indicate improvement in quality of life among the participants. Trial registration number not applicable

Determinants of Work-Life Balance Among Police Officers: a Systematic Review Study

Objective: This study aims to identify the main factors affecting work-life balance among police officers. Method: This systematic literature review uses Bibliometrix software to identify relevant articles in the Web of Science and Scopus databases. After applying the inclusion and exclusion criteria, 19 articles were selected and analyzed. Results and Discussion: The main factors identified include competitive organizational culture, lack of family-friendly policies, shift rotations, unpredictable schedules, occupational stress, and the absence of supportive measures for work-life balance. These factors significantly impact the physical and psychological well-being of police officers, contributing to issues such as PTSD, chronic fatigue, and job dissatisfaction. Research Implications: Implementing family-friendly policies, ensuring flexible and predictable work schedules, and providing adequate organizational support can significantly improve work-life balance among police officers, leading to greater job satisfaction and the effectiveness of police forces. Originality/Value: This study contributes to the literature by systematically identifying and analyzing the main factors affecting work-life balance among police officers, providing insights into policies and practices to improve their well-being.

P-281 Surgery and IVF for diagnosed ovarian endometriosis and deep infiltrative endometriosis

Abstract Study question To evaluate the effectiveness of surgical treatment of endometrioid cysts and deep infiltrative endometriosis before an IVF program Summary answer Laparoscopic excision of deep infiltrative endometriosis has a positive effect on the reproductive function of women What is known already One of the most severe and aggressive manifestations of endometriosis is deep infiltrative endometriosis. Endometriosis is a socially significant disease that reduces a woman’s quality of life and affects reproductive health. Women with endometriosis often experience severe menstrual and non-menstrual pain affecting the lower abdomen, pelvis or lumbosacral region, profound dyspareunia, dyschezia and dysuria (Uimari et al., 2021) and infertility in 30–50% of cases (Prescott et al.., 2016). Patients with endometriosis suffer from chronic fatigue (Ramin-Wright et al., 2018) and have a higher risk of mental health problems (56.4%) than patients without endometriosis (43.6%) (Pope et al., 2015) Study design, size, duration The our institute is conducting a controlled, non-randomized, retro- and prospective study on genital endometriosis. The study period is from 2012 to the present. Participants/materials, setting, methods The study included 450 women with deep infiltrating endometriosis in combination with infertility All patients were divided into 4 groups Group 1 – 128 patients with deep infiltrative endometriosis, sent for IVF without surgery Group 2 – 297 patients with deep infiltrative endometriosis, initially referred for surgery Group 2a – 156 patients with ovarian cysts, sent for preliminary collection of eggs before surgery Group 2c – 141 patients with ovarian cysts, referred for surgery without prior egg retrieval Main results and the role of chance In group 1, the number of pregnancies occurred was 65.6% (84 women), in group 2a - 71.7% (112 women), in group 2 - 53.9% (76 women). Pregnancy occurred spontaneously in 18 (4.2%) women from group 2 after surgery. In group 2, four women, after three unsuccessful attempts at in vitro fertilization, became pregnant after using donor eggs - the results were excluded from the final pregnancy calculations. In terms of pregnancy, IVF with preliminary surgery (Me: 2.10; Q1-Q-3:0) had a statistically significant advantage compared to IVF without surgery (Me: 5.00; Q1-Q-3:0), and IVF with surgery without egg retrieval (Me:3.0; Q1-Q-3:0). The lowest statistically significant pregnancy rate was recorded during laparoscopic surgery without prior egg retrieval (Me: 6.95; Q1-Q-3:1). When performing a post-hoc analysis, a statistically significant shorter pregnancy time was also found when performing IVF with preliminary laparoscopy and egg freezing: group 1 (M: 126.25; SD111.1), group 2a (M: 79.97; SD: 19.785 ), group 2c (M: 130.50; SD: 82.149) (p = 0.000). During the period of observation of women for twelve years after surgery, 93% of patients noted an improvement in the quality of life and 63.7% of women on average achieved reproductive function after the IVF program for endometriosis. Limitations, reasons for caution no restrictions Wider implications of the findings The results of the IVF program for deep infiltrative endometriosis are statistically higher after surgery, but with preliminary cryopreservation of oocytes. The question of radical resection of the rectum in comparison with shaving when planning an IVF program remains open, which forms the planning of further research in this area. Trial registration number not applicable

Effects of Diathermy on Pain in Women with Fibromyalgia: A Randomized Controlled Trial.

(1) Background: The main characteristic of fibromyalgia (FM) is generalized musculoskeletal pain. This may be accompanied by muscle and joint stiffness, sleep and mood disorders, anxiety and depression, cognitive dysfunction, and chronic fatigue. It is endemic in developed countries, with a higher prevalence among women than men, and its etiology is still unknown. Diagnosis is made based on chronic generalized pain and through the presence of tender points. The objective of this study was to analyze the efficacy of diathermy on pain in patients with fibromyalgia. (2) Methods: A single, blind, randomized experimental study was developed with a sample of 31 participants. Measurements were taken and recorded at three different intervals using the following measurement tools: the pressure pain threshold (PPT) at the tender points (TP) of the right and left trochanteric prominence with an algometer, the pain measurement scale, the Fibromyalgia Impact Questionnaire, the sleep quality index (PSQI, Pittsburgh), the Multidimensional Fatigue Inventory (MFI-S), and the scale for anxiety and depression (Hospital Anxiety and Depression Scale). Sociodemographic data were collected through Google Forms (age, height, weight, Body Mass Index). The intervention took place twice weekly across four weeks of sessions. (3) Results: Statistically significant results were obtained in the right and left trochanter PPT, as well as for anxiety and fatigue in the experimental group. The results obtained show that this treatment has managed to improve the quality of sleep, the impact of disease, chronic fatigue, and anxiety in patients with FM. (4) Conclusions: Diathermy is a tool that can help reduce pain. It can also improve the baseline levels of chronic fatigue, anxiety, the impact of the disease, and sleep quality in patients with fibromyalgia.

Cerebral Microvascular Density, Permeability of the Blood-Brain Barrier, and Neuroinflammatory Responses Indicate Early Aging Characteristics in a Marfan Syndrome Mouse Model.

Marfan Syndrome (MFS) is a connective tissue disorder due to mutations in fibrillin-1 ( Fbn1 ), where a Fbn1 missense mutation ( Fbn1 C1039G/+ ) can result in systemic increases in the bioavailability and signaling of transforming growth factor-β (TGF-β). In a well-established mouse model of MFS ( Fbn1 C1041G/+ ), pre-mature aging of the aortic wall and the progression of aortic root aneurysm are observed by 6-months-of-age. TGF-β signaling has been implicated in cerebrovascular dysfunction, loss of blood-brain barrier (BBB) integrity, and age-related neuroinflammation. We have reported that pre-mature vascular aging in MFS mice could extend to cerebrovasculature, where peak blood flow velocity in the posterior cerebral artery (PCA) of 6-month-old (6M) MFS mice was reduced, similarly to 12-month-old (12M) control mice. Case studies of MFS patients have documented neurovascular manifestations, including intracranial aneurysms, stroke, arterial tortuosity, as well as headaches and migraines, with reported incidence of pain and chronic fatigue. Despite these significant clinical observations, investigation into cerebrovascular dysfunction and neuropathology in MFS remains limited. Using 6M-control ( C57BL/6 ) and 6M-MFS ( Fbn1 C1041G/+ ) and healthy 12M-control male and female mice, we test the hypothesis that abnormal Fbn1 protein expression is associated with altered cerebral microvascular density, BBB permeability, and neuroinflammation in the PCA-perfused hippocampus, all indicative of a pre-mature aging brain phenotype. Using Glut1 staining, 6M-MFS mice and 12M-CTRL similarly present decreased microvascular density in the dentate gyrus (DG), cornu ammonis 1 (CA1), and cornu ammonis 3 (CA3) regions of the hippocampus. 6M-MFS mice exhibit increased BBB permeability in the DG, CA1, and CA3 as evident by Immunoglobulin G (IgG) staining, which was more comparable to 12M-CTRL mice. 6M-MFS mice show a higher number of microglia in the hippocampus compared to age-matched control mice, a pattern resembling that of 12M-CTRL mice. This study represents the first known investigation into neuropathology in a mouse model of MFS and indicates that the pathophysiology underlying MFS leads to a systemic pre-mature aging phenotype. This study is crucial for identifying and understanding MFS-associated neurovascular and neurological abnormalities, underscoring the need for research aimed at improving the quality of life and managing pre-mature aging symptoms in MFS and related connective tissue disorders.

Perceived Strengths and Difficulties in Children and Adolescents With Chronic Physical Health Conditions

Abstract: Theoretical Background: The Strengths and Difficulties Questionnaire (SDQ) is often used for screening of psychological problems in children with chronic physical health conditions (CPHC). Objective: The present meta-analysis tested (a) whether the SDQ scores of young people with CPHC show elevated psychological symptoms and lower prosocial behavior compared with healthy peers or test norms, (b) which conditions are associated with the strongest increase in symptoms, and (c) whether results vary by sample and study characteristics. Method: Studies that compared SDQ scores between young people with CPHC and healthy peers or test norms or that provided sufficient information for a comparison with established normative data or sociodemographically equivalent healthy groups from that country, and if studies were published or made available online before July, 2023, were included in the meta-analysis. Study quality was evaluated with the Mixed Methods Appraisal Tool. A systematic search in the electronic databases Medline, PsycINFO, PSYNDEX, Web of Science, and the SDQ database resulted in 605 studies of 217,440 children and adolescents with CPHC that were included in random-effects meta-analyses. Results: There were, on average, small-to-moderate elevations in total difficulties (parent/self-report: g = .52/.31) and the four problem scales as well as slight reductions in parent reports on prosocial behavior ( g = -.17). Elevations in parent- and self-reports on emotional symptoms ( g = .48/.31) and peer problems ( g = .43/.26) were significantly stronger than elevations in conduct problems ( g = .30/.10) and hyperactivity–inattention ( g = .33/.13). In addition, children with cerebral palsy (parent/self-report of total problems: g = .82/.66), chronic fatigue syndrome ( g = .82/.66), and epilepsy ( g = .95/.40) showed above-average elevations in psychological symptoms. Stronger effect sizes were found, among others, in older children and in the case of a later age at onset. Direct comparisons of the results of published and unpublished studies on self-rated SDQ found some evidence for a possible publication bias, while results of published and unpublished studies did not vary when parent ratings were used. With regard to limitations, only few studies were available on teacher ratings and from non-Western countries. Illness-specific analyses were impossible for rarely assessed conditions, such as cystic fibrosis and spina bifida. Discussion and Conclusion: It is concluded that children with epilepsy, cerebral palsy, chronic fatigue syndrome, and other conditions affecting the brain should be, in particular, screened for psychological problems. Symptom overlap of some CPHC with the Emotional Symptoms scale has to be considered when interpreting the data.

Predictors of response to a dietary intervention in patients with irritable bowel syndrome

BackgroundDifferent diets have emerged as potential therapeutic options for patients with irritable bowel syndrome (IBS). ObjectiveTo identify predictors of improvement after a low-FODMAP, low-starch and low-sucrose diet among patients with IBS. MethodsWe performed a descriptive cross-sectional study including patients with IBS according to Rome IV criteria undertaking a social-media based program with a two-week dietary intervention. Patients completed an online survey before and after the intervention including the presence of intestinal and extra-intestinal symptoms, the IBS-SSS (irritable bowel syndrome symptoms severity scale) and the PHQ-9 (patient health questionnaire-9). Clinical improvement was defined as a decrease of at least 50% in IBS-SSS post dietary intervention. Variables associated with symptomatic response were identified with logistic regression analysis. A clinical score to predict response was created and tested with a with a receiver operating characteristic (ROC) curve analysis. ResultsA total of 3583 patients with IBS were included. Mean IBS-SSS before and after dietary intervention was 295.5±52.32 and 240±48.66, respectively (p=0.01); 1178 (32.8%) patients showed clinical improvement. A mean basal IBS-SSS >400 (OR 3.04), chronic headache (OR 1.96), and chronic fatigue (OR 1.81) were significantly associated with symptomatic response. Patients with arthralgia (OR 0.41) and/or fibromyalgia (OR 0.33) were less likely to improve. Each variable received the following individuals scores: IBS-SSS >400: +2, chronic headache: +1.5, chronic fatigue: +1, arthralgia: −1, and fibromyalgia: −1. The ROC curve analysis of the proposed score showed an area under the curve of 0.72 (95% CI 0.69–0.76). A score ≥3 had a sensitivity of 72.64% and specificity of 60.56% for predicting symptomatic improvement. ConclusionsThere are clinical variables that could serve as reliable predictors of response to a low-FODMAP, low-sucrose, low-starch diet among patients with IBS. Further research is needed to understand the link between the presence of extra-intestinal symptoms and clinical improvement after dietary interventions for IBS.

What Makes It Tick: Exploring the Mechanisms of Post-treatment Lyme Disease Syndrome.

Post-treatment Lyme disease syndrome (PTLDS), which may also be referred to incorrectly as "chronic Lyme disease," is defined by the Infectious Diseases Society of America (IDSA) as the presence of fatigue, pain, and/or cognitive complaints with the functional impact that persists for more than six months after completing treatment for Lyme disease (LD). These symptoms occur in 10%-20% of patients previously diagnosed with LD caused by the bacteria Borrelia burgdorferi and appropriately treated with a course of antibiotics. The symptoms of PTLDS can be easily overlooked or misdiagnosed as a psychiatric manifestation in geographic locations that rarely see LD. In contrast, geographic locations with a higher prevalence of LD may be more aware of PTLDS symptoms and have higher clinical suspicion leading to this diagnosis. The pathophysiology behind the persistent symptoms some people experience from a primary infection is still largely unknown. Some mechanisms that have been proposed include permanent tissue damage and inflammation, immune system dysfunction, autoimmune response, co-infection, and even persistent infection refractory to treatment. We propose that ongoing PTLDS symptoms seem to be related to an autoimmune response to the tissue damage and inflammation caused by the viable or nonviable spirochete pathogen. At this point, PTLDS is diagnosed clinically as no quantifiable methods are available from laboratory or tissue diagnostics as of 2024. Similar pathophysiological features of PTLDS are seen in diseases such as COVID-19 or chronic fatigue syndrome (CFS). More effective diagnostic approaches might include further studies looking at a possible connection in the genomes of individuals developing PTLDS, quantifiable biomarkers, common inflammatory markers/pathways, and careful histopathological studies of human tissues.

Effect of Cognitive-behavioral Stress Management Therapy on Pain Perception, Chronic Fatigue and Cognitive Empowerment of Women With Fibromyalgia Syndrome: A Randomized Clinical Trial

Effect of Cognitive-behavioral Stress Management Therapy on Pain Perception, Chronic Fatigue and Cognitive Empowerment of Women With Fibromyalgia Syndrome: A Randomized Clinical Trial

The Relative Contribution of the Emotional Suppression in Predicting Chronic Fatigue Syndrome among Female Students of Umm Al-Qura University at Makkah Al Mukarramah

This study aims to determine the level of implementing the strategy of the emotional suppression by Umm Al Qura University female students, to know the prevalence rate of the chronic fatigue syndrome among female students of Umm Al Qura University, to know the relationship between the use of the emotional suppression strategy and the feeling of the chronic fatigue syndrome, and to know the differences between female students of Umm Al Qura University in using the strategy of the emotional suppression and the Chronic fatigue syndrome according to marital status and age, revealing the possibility of predicting the feeling of the chronic fatigue syndrome through the scores achieved by Umm Al Qura University female students on the scale of the emotional suppression prepared by Al-Khairi and Taleb (2017), and the chronic fatigue scale prepared by Abdul Khaleq and Al Dheeb (2006) Using the descriptive, predictive method . The study was applied to a Random sample of (417) female students at Umm Al Qura University in Makkah Al Mukaromah. The results revealed that the level of emotional suppression among Umm Al Qura University female students is higher than the average. The prevalence of the chronic fatigue syndrome is less than the average, while the prevalence of the chronic fatigue according to the used test (the median) ranged between (47.4-48.4%) among university female students for the dimensions and the total score. The value of the correlation coefficient between the students' scores on the emotional suppression scale and their scores on the chronic fatigue syndrome scale was positive and indicative Moreover, the results showed that the emotional suppression predicted the chronic fatigue syndrome by (19%).

Association of Body Mass Index with Pain Perception, Anxiety, Depression, and Disability in Fibromyalgia Patients

Background: A disorder of uncertain origin, Fibromyalgia (FM) is accompanied by pervasive pain, tiredness, disturbed sleep, and cognitive deficit. It has been related to depression, manic-depressive illness, and chronic fatigue. FM is negatively affected by obesity on both clinical and biological parameters. Methods: A total of n=150 FM patients (132 Female and 18 Male) were included in the study. Initially, informed consent and demographic data were gathered from the participants. Afterwards, each patient's Body Mass Index (BMI) was calculated and classified into average weight, overweight, and obese categories. The Numeric Pain Rating Scale (NPRS) was used to quantify the intensity of pain, the Hamilton Anxiety Scale (HAM-A) was used to determine the participants’ anxiety levels, the Hamilton Rating Scale for Depression (HAM-D) was used to examine their depression levels, and Health Assessment Questionnaire Disability Index (HAQ-DI) was used to measure their functional status. All these questionnaires were self-administered by the participants. Results: In the NPRS, HAM-A, HAM-D, and HAQ-DI categories, no significant differences were found (p>0.05). However, between the BMI level and anxiety, a weak positive correlation was detected (r=0.195, p=0.017). BMI levels were not statistically significantly correlated with pain, depression, or disability (r=0.011, p=0.0897; r=0.048, p=0.562; r=0.072, p=0.383). Conclusion: The results of the study revealed that there is no significant association of pain perception, anxiety, depression and disability with increasing BMI among FM patients except for a weak positive correlation with anxiety. Keywords: Body Mass Index, Fibromyalgia, Pain, Obesity.